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Febrile Patients (febrile + patient)

Distribution by Scientific Domains

Medical Sciences	90%

Selected Abstracts

The role of procalcitonin in a decision tree for prediction of bloodstream infection in febrile patients

CLINICAL MICROBIOLOGY AND INFECTION, Issue 12 2006
R. P. H. Peters
Abstract Bloodstream infection (BSI) in febrile patients is associated with high mortality. Clinical and laboratory variables, such as procalcitonin (PCT), may predict BSI and help decision-making concerning empirical treatment. This study compared two models for prediction of BSI, and evaluated the role of PCT vs. clinical variables, collected daily in 300 consecutive febrile inpatients, for 48 h after onset of fever. Multiple logistic regression (MLR) and classification and regression tree (CART) models were compared for discriminatory power and diagnostic performance. BSI was present in 17% of cases. MLR identified the presence of intravascular devices, nadir albumin and thrombocyte counts, and peak temperature, respiratory rate and leukocyte counts, but not PCT, as independent predictors of BSI. In contrast, a peak PCT level of >2.45 ng/mL was the principal discriminator in the decision tree based on CART. The latter was more accurate (94%) than the model based on MLR (72%; p <0.01). Hence, the presence of BSI in febrile patients is predicted more accurately and by different variables, e.g., PCT, in CART analysis, as compared with MLR models. This underlines the value of PCT plus CART analysis in the diagnosis of a febrile patient. [source]

Procalcitonin and other markers of infection.

CLINICAL MICROBIOLOGY AND INFECTION, Issue 2 2002
What should be their role in clinical practice?
Clinicians are always faced with a decision when confronted with a febrile patient; they must decide between what is an infectious condition and what is not, and between what merits hospital observation, what requires empirical antibiotic treatment and what needs outpatient follow-up. In this respect, judgement based on medical history and physical examination outweigh the predictive value of various laboratory markers of infection, as the latter generally reflect a nonspecific reaction of the host to widely different infectious and inflammatory stimuli. In the evaluation of specific subgroups of patients, e.g. those in the intensive care unit, laboratory tests should also preferably form a continuum with medical history and physical examination, aimed at clarifying host condition, the setting and the source of a possible infection. [source]

Haematological parameters in severe acute respiratory syndrome

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 1 2005
W. J. CHNG
Summary Clinical presentation of severe acute respiratory syndrome (SARS) is non-specific and isolation of all suspected patients is difficult because of the limited availability of isolation facilities. We studied changes in haematological parameters in SARS patients using median values analysed according to the day of symptom onset. White cell (WCC), absolute neutrophil, absolute lymphocyte (ALC) and platelet counts followed a v-shaped trend with the nadir at day 6 or 7 after symptom onset except for ALC in the ICU group that had not reached the nadir by day 12. None of our patients had a platelet count < 80 × 109/l and WCC < 2 × 109/l in the first 5 days of symptoms and these parameters may allow early stratification of febrile patients into likely and unlikely SARS cases to allow effective utilization of isolation facilities. On multivariate analysis, age is the only independent predictor for ICU admission. [source]

Characteristics of and interventions for fever in Japan

INTERNATIONAL NURSING REVIEW, Issue 4 2004
Y. Ikematsu rn
Abstract Purpose:, As part of a larger multinational validation study of the International Classification for Nursing Practice (ICNP®) alpha version, a survey was conducted in Japan to determine characteristics of ,fever' and interventions to treat febrile patients. Sample:, Three hundred and fifty-six acute and critical care Japanese nurses participated in this study. Method:, The major and minor characteristics of ,fever' perceived by Japanese nurses and interventions used by the nurses in managing febrile patients were identified using the Diagnostic Content Validity (DCV) model. Results:, Two characteristics, ,increased body temperature' and ,chills' were selected as major characteristics from the standardized list of the ICNP® alpha version validation study. Nine characteristics among the standardized list of characteristics were rated as minor characteristics, and six of the ICNP® characteristics were rejected. ,Shivering' and ,infectious lab data' were added with a level of representativeness similar to a major characteristic by nine of the nurses. A variety of interventions to treat fever were reported. The most frequently reported intervention was cooling, followed by warming and medication. Nine dimensions were derived from all reported interventions. Discussion:, As well as perceived characteristics of fever, these interventions may have aspects unique to Japanese nursing practice and to the acute and critical care settings. These results can be compared to those of other populations in future studies. [source]

Blood cultures for febrile patients in the acute care setting: Too quick on the draw?

JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 11 2008
ACNP-BC, Barbara K. Chesnutt MSN
Abstract Purpose: To review the fever literature and determine how 38.3°C was deemed the optimal fever threshold that predicts bacteremia. Data sources: PubMed, MEDLINE, Cochrane database, and the Cumulative Index to Nursing and Allied Health. Conclusions: A temperature of 38.3°C has come to be the threshold value that typically triggers diagnostic fever evaluation for bacteremia in hospitalized patients. Studies that define predictors of bacteremia provide conflicting results, and most bacteremia predictor models have not been externally validated. Therefore, current fever guidelines are based on consensus opinion rather than large clinical trials identifying a specific threshold with high sensitivity and a high negative predictive value. Implications for practice: The use of a single temperature threshold of 38.3°C for the prediction of bacteremia is not sufficient in all patients. Additional factors should be considered, including patient population, supporting clinical signs and symptoms, and the patient's medical history. [source]

Development of recombinant OmpA and OmpB proteins as diagnostic antigens for rickettsial disease

MICROBIOLOGY AND IMMUNOLOGY, Issue 7 2009
Eun-Ju Do
ABSTRACT In this study the diagnostic potential of Rickettsia conorii recombinant antigens was analyzed. For this, site-specific PCR primers were used to clone the OmpA and OmpB genes of R. conorii into pMAL-c2X plasmids. Six fragments of OmpA and four of OmpB were expressed as fusion proteins with maltose-binding protein in Escherichia coli. OmpA1350-1784, OmpB801-1269, and OmpB1227-1634 regions from truncated proteins were selected as diagnostic candidate antigens by ELISA using control sera. ELISA results of three antigens were compared to the results obtained by using a commercial ELISA kit which contained whole OmpA and OmpB antigens from R. conorii. For this analysis, 40 serum samples taken from febrile patients and uninfected controls were tested. Of the 20 R. conorii test results which were positive with the commercial kit, 18 were shown to be positive by ELISA using OmpA1350-1784 (a sensitivity of 90%). The specificity of the ELISA was 100%; all of the 20 samples shown to be negative using the commercial kit were also negative in our assay. The sensitivities of the ELISA using the OmpB801-1269 and OmpB1227-1634 were 90% and 95%, respectively. The specificities of the OmpB801-1269 and the OmpB1227-1634 were 100% and 95%, respectively. These results suggest that specific regions of OmpA and OmpB effectively detect antibodies against R. conorii, and the truncated recombinant antigens could be used for development of diagnostic tools for rickettsial disease. [source]

Variation in Ancillary Testing among Pediatric Asthma Patients Seen in Emergency Departments

ACADEMIC EMERGENCY MEDICINE, Issue 6 2007
MHSA, Rachel M. Stanley MD
Background:Variation in the management of acute pediatric asthma within emergency departments is largely unexplored. Objectives:To investigate whether ancillary testing for patients with asthma would be associated with patient, physician, and hospital characteristics. Methods:The authors performed an analysis of a subset of patients from an extensive retrospective chart review of randomly selected charts at all 25 member emergency departments of the Pediatric Emergency Care Applied Research Network. Patients with a diagnosis of asthma were selected for supplemental review and included in this study. Ancillary tests analyzed were chest radiographs and selected blood tests. Hierarchical analyses were performed to describe the associations between ancillary testing and the variables of interest. Results:A total of 12,744 chart abstractions were completed, of which 734 (6%) were patients with acute exacerbations of asthma. Overall, 302 patients with asthma (41%) had ancillary testing. Of the 734 patients with asthma, 198 (27%) had chest radiographs and 104 (14%) had blood tests. Chest radiographs were more likely to be ordered in patients with fever. Less blood testing was associated with physician subspecialty training in pediatric emergency medicine, patients treated at children's hospitals, higher patient oxygen saturation, and patient disposition to home. Conclusions:Ancillary testing occurred in more than one third of children with asthma, with chest radiographs ordered most frequently. Efforts to reduce the use of chest radiographs should target the management of febrile patients with asthma, whereas efforts to reduce blood testing should target providers without subspecialty training in pediatric emergency medicine and patients treated in nonchildren's hospitals who are more ill. [source]

Optimization of the detection of microbes in blood from immunocompromised patients with haematological malignancies

CLINICAL MICROBIOLOGY AND INFECTION, Issue 7 2009
S. Skovbjerg
Abstract The present study aimed to improve the rate of detection of blood-borne microbes by using PCRs with pan-bacterial and Candida specificity. Seventeen per cent of the blood samples (n = 178) collected from 107 febrile patients with haematological malignancies were positive using standard culture (BacT/Alert system). Candida PCR was positive in 12 patients, only one of whom scored culture-positive. Bacterial PCR using fresh blood samples was often negative, but the detection rate increased when the blood was pre-incubated for 2 days. These data indicate that PCR assays might be a complement for the detection of blood-borne opportunists in immunocompromised haematology patients. [source]